A Smartphone-Based Implicit Theories Intervention for Health Behavior Change: Randomized Trial

Abstract

Background: Implicit theories of health describe individuals' beliefs about the malleability of health. Individuals with an incremental theory of health believe that health, in general, is malleable, whereas individuals with an entity theory of health endorse the idea that health is largely fixed and predetermined. Previous research has shown that an incremental theory of health is associated with beneficial health outcomes and behaviors. A mobile health implicit theories intervention could be an effective way to increase health-promoting behaviors in the general population.

Objective: The aim of this study was to estimate the effect of a smartphone-based intervention designed to promote an incremental theory of health on the frequency of health-promoting behaviors in everyday life. The study used ecological momentary assessment to measure health behavior change.

Methods: This 2-arm, single-blind, delayed intervention design included 149 German participants (mean age 30.58, SD 9.71 years; n=79 female). Participants were asked to report their engagement in 10 health-promoting behaviors throughout the day for 3 weeks. Participants were randomly assigned to either an early intervention group (n=72) or a delayed intervention group (n=77). The intervention materials, designed to promote an incremental theory of health, were provided to participants after 1 week (early intervention group) or 2 weeks (delayed intervention group) of baseline behavior measurement. Data for this study were collected between September 2019 and October 2019.

Results: A paired-samples 2-tailed t test revealed that participants reported a stronger incremental theory after responding to the intervention materials (mean 5.58, SE 0.07) compared with incremental theory measured in an entry questionnaire (mean 5.29, SE 0.08; t₁₄₈=4.07, SE 0.07; P<.001; 95% CI 0.15-0.43; d=0.33). Multilevel analyses showed that participants reported engaging in health-promoting behaviors more often after being presented with the intervention materials compared with baseline across conditions (b=0.14; t_146.65=2.06, SE 0.07; P=.04; 95% CI 0.01-0.28). However, when the analysis was conducted separately for the early and delayed intervention groups, the intervention effect was only significant for the delayed intervention group (b=0.27; t_1492.37=3.50, SE 0.08; P<.001; 95% CI 0.12-0.42). There was no significant increase in health-promoting behaviors for the early intervention group (b=0.02; t_69.23=0.14, SE 0.11;P=.89; 95% CI -0.2 to 0.23).

Conclusions: This study suggests that a smartphone-based intervention designed to promote an incremental theory of health is a cost- and time-effective approach to increase the frequency of engaging in health-promoting behaviors. However, research is needed to understand the reasons for the difference in intervention effects between the early and delayed intervention groups. The results of this study can guide the development of future digital health interventions that focus on implicit theories to promote health behavior change.

Trial registration: DRKS - German Clinical Trials Register DRKS00017379; https://drks.de/search/de/trial/DRKS00017379.

Keywords: daily diary; ecological momentary assessment; health behavior; implicit theories; lay theories; mindsets; multiple health behavior change; randomized trial; smartphone-based intervention.